PMR Flare Up

[KCRoyals]

Went from 15mg pred to 1mg and have had continual pain although my CRP is okay. Now put on 10mg for 3 weeks then to go straight back to 3mg. Anyone done such a drop. My rheumy says these are the guidelines and also my GP agrees. How come there are a 1001 differing opinions on everything to do with PMR.

[PMRpro Ambassador]

Heaven only knows WHAT guidelines - I've never seen any saying that!

I'm sorry - I don't agree. I don't think you could be on 10mg for 3 weeks and drop to 3mg comfortably. It might be safe enough - but personally I would do a week to 10 days of 10mg (which should actually be enough to clear out the effects of the flare), a week of 7.5mg and a week of 5mg. And I wouldn't tell how I tapered back down.

But the crux of the matter is - where were you last reasonably comfortable? What result did you achieve at 15mg? That should be your guide - you should never feel worse after a reduction than you did before and you are looking for the lowest dose that works as well as 15mg did.

[KCRoyals in reply to PMRpro]

Great answer and I'll do that. My problem is that I don't fully understand ageing pains and whether it's natural to have pains at 64 which ain't considered old anymore. Apparently the latest medical criteria for old age is 80.

[PMRpro Ambassador in reply to KCRoyals]

B*££*"&$ - who on earth thought that up!! There are a lot of people suffering from diseases of old age long before 80! Or do they mean that they now consider doing procedures for people up to 80 whereas before the age limit was lower? Cardiac surgery in over 80s is common now but even only a few years ago it would have been considered too risky.

There are different old age criteria for different things - medical insurance, driving licence, benefits etc. But medically and biologically speaking the elderly patient is over 65 and in some cases younger.

[piglette]

I think your rheumie may have meant there are guidelines on reducing, not on dropping suddenly from 10mg to 3mg, which does sound it could cause problems if you are having continual pain. CRP can be OK irrespective for around 20% of people and never rises which can make a bit difficult to diagnose anything.